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102 Cards in this Set

  • Front
  • Back
define Akathisia:
motor restlessness, compelling urge to move about.
define akinesia
abrroup stoppage of voluntary movement
define bradykinesia
slowness in initiating voluntary movement
define athetosis
slow, twisting and porpuseless movements
define chorea
arrhythmic, rapid, brief muscular contractions
combination of distal chorea and proximal athetosis
define dyskinesia
difficulty in performing voluntary movements; can be spontaneous or drug induced AIMS
what does AIMS stands for:
Abnormal Involuntary MovementS
define dystonia
slow, sustained muscle contractions often resulting in postural abnormality
define myoclonic
brief muscle contractions producing quick, jerking movements
define tics
brief, sudden contractions of a muscle or group of muscles that results in repetitive and purposeless movements and vocalizations
rhythmic, oscillatory movements of parts of the body due to alternating contractions of opposing muscles at a joint (back and forth)
define Movement disorders
extrapyramidal or basal ganglial disorders; a diverse group of idiopathic and drup-induced (iatrogenic) conditions characterized by non-epileptic involuntary movements (AIMS)
define parkinsonism
Any of a group of nervous disorders similar to Parkinson's disease, marked by muscular rigidity, tremor, and impaired motor control and often having a specific cause, such as the use of certain drugs or frequent exposure to toxic chemicals.
define parkinson's disease
a common neurologic disease believed to be caused by deterioration of the brain cells that produce dopamine, occurring primarily after the age of 60, characterized by tremors, esp. of the fingers and hands, muscle rigidity, shuffling gait, slow speech, and a masklike facial expression.

commonly occurring, chronic, progressive
define Iatrogenic Parkinsonism
commonly occuring acute condition
what is MPTP?
1-methyl-4-phenyl-1,2,3,6,-tetrahydropyridine. Analog of the illicity meperidine, which produces severe permanent Parkinsonism.
define Iatrogenic:
Pathophysiology of parkinsonism disorders:
1. selective degeneration of substantia niagra--striatal Dopamine Neurons--(idiopathic or MPTP)
2. Blockade of DA receptors in striatal areas (neuroleptics)
3. loss of DA function coupled with sparing of ACh function
Idiopathic parkinsonism:
Parkinson's disease (old age, not drug induced)
Acetocholin (ACh) is excitatory or inhibitory?
largely excitatory
Dopamine (DA) is excitatory or inhibitory?
largely inhibitory
Signs and symptoms of parkinsonism:
R: rigidity of muscles
A: Akinesia
F: Flat/Fixed facial expression
T: tremor at rest

others: unblinking, drooling, hypophonia, micrographia.
trademark for a tablet preparation used in the symptomatic treatment of parkinsonism. Preparation containing carbidopa and L-dopa.
Cabidopa Mechanism of action
inhibits dopa decarboxylase in periphery, but not in the CNS because doe not cross the BBB.
Levodopa mechanims of action
a synthetic substance that is converted in the brain to dopamine increasing DA levels in the brain. Used chiefly in the treatment of parkinsonism.
Drug of choice for idiopathic parkinsonism (Parkinson's Disease):
Sinemet (levodopa + carbidopa)
Sinemet (Levodopa + carbidopa) Adverse Effects:
1. Nausea, vomiting, anorexia
2. orthostatic hypotension
3. cardiac arrhythmias
4. choreiform & dystonic movements (long term)
5. dementia & psychotic symptoms (long term)
6. On-Off phenomenon
7. serious psychiatric symptoms
Why is a "drug holiday" given to some patients taking Sinemet?
A drug holiday, where levodopa is not given for at least 5 days, is recommended to patients that develop serous psychiatric and/or AIMS
what are the consequences of a Sinemet drug holiday?
re-emerging of parkinson symptoms
Sinemet (levodopa + carbidopa) contraindications:
1. MAO Inhibitors
2. Neuroleptics
3. Tricyclic antidepressants
4. anti-cholinergics
5. protein-rich meals
what is the effect of taking Sinemet along with a MAO Inhibitor:
this combination causes hypertensive and hyper-pyrexia crises
what is the effect of taking Sinemet along with a Neuroleptic:
neuroleptics antagonize the therapeutic effect of Sinemet
what is the effect of taking Sinemet along with a Tri-cyclic antidepressant:
TCA augment hypo-tension
what is the effect of taking Sinemet along with an anti-cholinergic:
anti-cholinergics delay the GI absorption of Sinemet
what is the effect of taking Sinemet with protein-rich meals:
Protein-rich meals reverse therapeutic effect
what does MAO stands for:
Monoamine oxidase
MAO converts:
converts MPTP to MPP
Treatments prescribed for Parkinsonism (idopathic/iatrogenic):
1. Dopanine prodrugs
2. Dopa decarboxilase inhibitor
3. DA agonists
4. DA reuptake inhibitors
5. MAO inhibitors
6. COMT inhibitors
7. Anti-cholinergics
8. Neurosurgery
DA prodrug
Dopa decarboxylase inhibitor
Anti-cholinergics used for idiopathic or iatrogenic parkinsonism
1. tri-hexy-phenidyl
2. Benz-tropine
3. Di-phen-hydramine (benadryl)
anticholinergics are used alone for
used alone for the treatment of mild cases of idiopathic parkinsonism (effectiveness: tremor>rigidity>>akinesia)
anticholinergics are used along with DA replacement therapy for:
used along with DA for the treatment of problem cases of idiopathic parkinsonism (effectiveness: tremor>rigidity>>akinesia)
anticholinergics used alone are the drug of choice for the treatment of:
iatrogenic-parkinsonism and dystonia
anticholinergic possesing H1 receptor antagonist effects
Di-phen-hydramine (benadryl)
Adverse effects of anticholinergics:
1. Xerostomia
2. urinary retention
3. constipation
4. blurred bision
5. palpitations
6. sedation
7. memory loss/delirium (@ high dose)
anticholinergics are contraindicated in
1. patients with glaucoma
2. patients older than 65 y.o. b/c may get dementia
Amantadine Mechanism of action
DA reuptake trasnporter inhibitor
Amantadine greatest limitation:
it develops tolerance
Drug used ocassionally in combination with DA-replacement therapy for cases of idiopathic parkinsonism, get initial improvement but develops tolerance:
Adverse effects of Amantadine:
1. hallucinations
2. confusion
3. livedo reticularis
what is livedo reticularis?
a condition of the peripheral blood vessels characterized by reddish blue spots of the skin especially of the extremities usually upon exposure to cold.

A purplish network-patterned discoloration of the skin caused by dilation of capillaries and venules.
type of drugs that should not be combined with amantadine (contraindication):
Dopamine Agonists
1. Bromocritine
2. Pergolide
3. Ropinirole
4. Pramipexole
DA agonist that is alone or more commonly with DA-replacement therapyfor idiopathic/iatrogenic parkinsonism particularly in patients with advanced disease:
Dopamine is also called:
PHI: prolacting Inhibiting Hormone
Dopanine agonist also used to treat amenorrhea, galactorrhea, and female infertility due to prolactin excess:
Adverse effects of bromocriptine
1. nausea, vomit
2. psychiatric symptoms
3. choreic and dystonic AIMS
Contraindications ffor DA agonist therapy:
Newer Dopamine analoges
1. Ropi-nirole
2. Prami-pexole
Selegilide mode of action
MonoAmine Oxidase Inhibitor (MAOI) used to enhance the effectivemess of DA-replacement.
MAO-inhibitor that delays the onset of disability associated with early cases of Parkinson's disease
Adverse effects of Selegiline (MAOI)
1. nausea/dizziness
2. mental changes
3. dyskinetic effects
Do DA agonists undergoes the same metabolism/transport than DA (true or false)
False, metabolic enzymes discriminate between DA and DA agonists.
Name two Catechol-O-methyl-transferase (COMT) inhibitors:
1. Enta-capone
2. Tol-capone
Mechanism of action of COMT inhibitors (-capones)
the "-capones" (COMT-inhibitors) inhibit the conversion of Dopa to methyl-dopa, so DA levels stay up
Either Enta-capone or tol-capone can be given adjunct to___ to increase Levodopa levels, thus prolonging DA on-time.
a 'capone" can be given adjunt to Sinemet
Adverse effects of "-capones" COMT-inhibitors
1. Dyskinesia
2. GI distress
3. Postural hypotennsion
4. acute hepatic Failure (tol-capone)
Before prescribing tolcapone one must carry liver function test since tolcapone___
can cause Acute hepatic failure
Invasive treatments for parkinson disease include
1. palliodotomy
2. transplantation of fetal brain tissue into PD patiens.
two major types of dystonias
1. idiopathic
2. iatrogenic
Idiopathic dystonias include
1. Meige's syndrome (blepharospasm oromandibular dystonia)
2. writers cramp
3. torsion dystonia

*usually chronic & slowly progressive
Iatrogenic distonias include
1. neuroleptic-induced dystonia
2. levodopa-induced dystonia

*usually acute conditions
Pathophysiology or primary dystonias:
treatments of dystonia are largely ineffective and not well tolerated. True or False
Most Common treatment for Idiopathic dystonias:
high-dose of anticholinergics
less common treatments for Idiopathic dystonias (given alone or w/ anti-cholinergics)
1. neuroleptics
2. reserpine
3. tetra-benazine
4. bromocriptine (Da agonist)
5. physo-stigmine (ACh inhibitor)
toxin approved by the FDA for the treatment of ble-phero-spasm, Meige's syndrome and spasmodic torticollis
Botox (Botullin toxin A); paralize muscle to lower contractions
Iatrogenic dystonias are commonly managed by a reduction in dose of ___ or ___. As a consequence, primary condition parkinson/psychosis worsens)
1. levodopa
2. neuroleptics
Iatragenic distonia may also be managed in most patients with anticholinergics. True or False
Types of chorea
1. Huntington's disease
2. sydeham's (rheumatic fever) chorea
3. Levodopa-induced chorea
Cause of Sydeham's (rheumatic fever) chorea
Streptococcal infection
No medication is effective against Sydeham's chorea, but its symptoms are eliminated once:
streptoccocal infection is eliminated
levodopa-induced chorea is managed by:
reducing levodopa dosage, but parkinsonian symptoms often worsen as a result
What is Huntington's disease (HD)?
1. rare autosomal dominant trait with gene defect on chromosome 4.
2. It is characterized by progressive brain neuronal death
3. causes chorea, dementia and depresion.
common drug treatment for huntington's disease:
1. neuroleptics, but they are often ineffective
2. accompanied by intolerable side effects (cognitive imparements, parkinsonian, dystonic AIMS)
what is Tourette's syndrome?
1. hereditary condition consistin of multiple motor and vocal tics.
2. life-long condition
3. spontaneous remission (month-years) occurs in some patients
Pathophysiology of Tourettes Syndrome?
DA hyperactivity since neurroleptics are the most effective treatments.
mention two drugs used to treat Tourettes syndrome and their side effects:
1. Haloperidol (Haldol)
2. Primozide (Orap)

*side effects: cognitive imparements and Parkinsonian/dystonic AIMS)
what are the signs of Essential tremor:
1. action/postural tremor occurring during voluntary movement not ar rest
2. chronic, slowly progressive, common
3. often hereditary
What is the pathophysiology of Essential tremor?
what are the most effective treatments against essential tremor? (hint: -olol)
1. propanolol (B-blocker)
2. metoprolol (B1-blocker, cardioselective)
3. atenolol (B1-blocker=cardioselect.)
4. Topiramate (anticonvulsant)
5. alcohol
*none eliminate tremor 100%
what movement disorder is atenolol, the cardioselective B1-blocker used for?
essential tremor
for what movement disorder is propanolol used?
essential tremor
for what movement disorder is metoprolol (B1-blocker, cardioselective) used for:
essential tremor
anticonvulsant used to treat essential tremor
alcohol is usually effective against essential tremor? true or false
action/postural tremors associated with dystonia, multiple sclerosis, & cerebellar disease are ussually controlled. true/false
False, these action/postural tremors are mostly unresponsive to all known drugs
what is Tardive Dyskinesia?
1. Is a late occurring side effect of chronic neuroleptic therapy and commonly
2. manifested by choreatetoid movements of lips, tongue and jaw.
3. unresponsive to all drugs
Movement disorders unresponsive to all known drugs:
1. action/postural tremor
2. tardive dyskinesia
Phathophysiology of Tardive Dyskinesia?
Presumably due to DA receptor hyper-sensitivity